JAMA otolaryngology-- head & neck surgery
September 1, 2026 · via Europe PMC
Postoperative Oral Dexamethasone and Pediatric Tonsillectomy Morbidity: A Randomized Clinical Trial.
Shaffer AD, Omar M, Maguire RC, +12 more, Chi DH.
AI summary — for doctors, generated from the abstract only
In a randomized trial of 209 children, a postoperative course of oral dexamethasone after tonsillectomy was associated with a considerable reduction in opioid prescriptions and emergency department visits for pain, though the reduction in overall pain scores was modest and the data were not precise enough for definitive conclusions about pain itself.
What was studied
A quadruple-blinded randomized controlled trial at a single tertiary academic center of 209 children (ages 3-17) undergoing adenotonsillectomy (2021-2023), comparing a postoperative course of oral dexamethasone (0.5 mg/kg, max 20 mg) versus placebo given on postoperative days 2, 4, and 6, with the primary outcome being mean pain score on days 2-8 and secondary outcomes including opioid prescriptions and healthcare utilization.
Key findings
- Among 131 patients who completed pain diaries, mean pain before analgesic medication on days 2-8 was 0.72 points lower in the dexamethasone group (4.12) than placebo (4.84), but wide confidence intervals and baseline pain differences prevented definitive conclusions about this primary outcome.
- The dexamethasone group had a considerable decrease in odds of receiving an opioid prescription (odds ratio 0.23, 95% CI 0.06-0.84) and of having an emergency department visit for pain (odds ratio 0.12, 95% CI 0.003-0.91), though the wide confidence intervals limit precision.
- Differences in readmissions, nursing phone calls, post-tonsillectomy hemorrhage, and return to normal diet between groups were small and clinically meaningless, indicating no increase in complications with dexamethasone.
Clinical relevance
The findings support considering postoperative oral dexamethasone as an analgesic adjunct after pediatric adenotonsillectomy, given its association with modestly less pain, considerably fewer opioid prescriptions, and fewer pain-related emergency department visits, without an increase in complications, per the study authors.
Who should care
Limitations
The authors explicitly caution that wide confidence intervals and differences in baseline pain before taking study medication limit definitive conclusions about the primary pain outcome; only 131 of 209 enrolled patients completed pain diaries and were included in the primary pain analysis, which could introduce some selection effects.
A short course of oral steroid medication after children's tonsillectomy was linked to meaningfully fewer opioid prescriptions and emergency room visits for pain, supporting its use as a helpful pain-management adjunct, though its direct effect on pain scores themselves was more modest and less certain.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Importance
Tonsillectomy is among the most painful otolaryngologic procedures. It is unclear whether a postoperative course of oral steroids reduces pediatric tonsillectomy pain and morbidity.
Objective
To determine whether a postoperative course of oral dexamethasone reduces postadenotonsillectomy pain in children.
Design, setting, and participants
This was a parallel-design quadruple-blinded randomized clinical trial conducted at a single tertiary academic center that enrolled pediatric patients (3-17 years of age) undergoing adenotonsillectomy from August 2021 to May 2023, with 14 days of follow-up for pain and 5 to 9 weeks for adverse events. Data were analyzed from October 2023 to May 2026.
Intervention
Oral dexamethasone (0.5 mg/kg; maximum dose, 20 mg) or placebo on postoperative days 2, 4, and 6.
Main outcome and measure
Mean (SD) pain score before medication administered during days 2 to 8 postoperatively.
Results
Of 763 children screened, 209 participants (median [IQR] age, 7.1 [5.8] years; 99 females [47.4%] and 110 males [52.6%]) were included (104 to the steroid arm and 105 to placebo) in analyses of adverse events and health care utilization. Of these, 131 (61 steroid arm and 70 placebo) completed pain diaries and were included in primary outcome (pain) analysis. Mean (SD) pain before acetaminophen or ibuprofen on days 2 to 8 was 0.72 (95% CI, 0-1.44) points lower in the dexamethasone group (4.12 [2.00]) than placebo (4.84 [2.15]), but wide 95% CIs and differences in pain prior to taking the study medication prevented making definitive conclusions. The dexamethasone group had less pre- and postanalgesic pain on postoperative days 12 and 13 (mean difference, 0.96-2.37 points) and a considerable decrease in odds of receiving an opioid prescription (odds ratio [OR], 0.23; 95% CI, 0.06-0.84) or having an emergency department visit for pain (OR, 0.12; 95% CI, 0.003-0.91). However, the precision of these estimates limits interpretability. Differences in readmissions, nursing telephone calls, posttonsillectomy hemorrhage, and return to normal diet between groups were small and clinically meaningless.
Conclusions and relevance
In this randomized clinical trial, postoperative oral dexamethasone was associated with a modest reduction in pain after pediatric adenotonsillectomy, a considerable reduction in opioid prescriptions, and no increase in complications, supporting its use as an analgesic adjunct.
Trial registration
ClinicalTrials.gov Identifier: NCT04879823.
DOI
10.1001/jamaoto.2026.1910
PMID
42490074
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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